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Child and Adolescent Health and Development |
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Evaluation and research |
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These two families of indicators, very broadly defined, are briefly described below[2]. The key message of this section is that plans should always include clear and measurable indicators that go beyond monitoring the “process” to include also the “outcome”, that is what the intervention should lead to, in relation to the main reason why certain activities have originally been planned. For example, training courses may be planned on counselling on child care. This is done: à to improve health providers’ counselling skills à to increase caretakers’ knowledge of child care à to improve caretakers’ child care practices (outcome) à to improve child health, e.g. reducing child deaths, illness or improving child growth and development (impact). Top
Process indicators refer to quantitative indicators selected to determine
whether planned activities took place, e.g. holding of a meeting with NGOs,
development and testing of health education materials or conduct of
communication skills training courses for community volunteers. In this category
one may include also output indicators, which are those adding more details in
relation to the output of the activity, e.g. the number and categories of
community health providers trained in communications skills, the number of
printed materials or radio programmes for health education developed, the number
and type of radio spots produced and broadcast. Indicators can also be selected
to monitor the quality of the activities conducted according to a number of
established quality criteria or standards.
Outcome indicators refer more specifically to the objectives of the intervention, that is its ‘results’, its outcome, the adoption of the recommended practice. These indicators indicate the reason why it was decided to conduct certain activities and are related to performance.
It is obvious that the target set for the final outcome indicator should be based on the targets for the process indicators and intermediate outcome indicators. For instance, in the example above, let us assume that in the pre-intervention phase only 20% of mothers are found to have good knowledge of how to care for a sick child. If it is planned to train 30% of all health providers in a community in counselling on home care, it would be unrealistic to expect all (100%) mothers in the community to receive good counselling, to have good knowledge of home care and care for their children properly as a result of the training intervention. These indicators, therefore, are of utmost importance. They should be monitored on a regular basis and plans for monitoring them should be included in the master plan for the intervention. Monitoring can include routine data collection, home visits, in-depth individual interviews, focus group discussions, observation of practices, intercept interviews, etc. It provides information not only about what is happening but also about why things are or are not happening. Monitoring of these indicators will tell us how the intervention needs to be modified during implementation. Communities should be involved in identifying solutions to the problems identified in the monitoring. An analysis of the progress towards achieving the targets set for these indicators will provide information valuable for the intervention and for future planning. Top
View the examples illustrating the logical “flow of indicators” from process to outcome and impact. It is understood that more than one strategy is often needed to achieve a certain objective, especially if the objective concerns changes in family practices, and each strategy needs clear indicators and targets of its own. However, in the following examples, each example shows only one set of indicators per intervention, in order to illustrate the logic of the “flow” and keep the examples simple and straightforward. Top
World Health Organization, Department of Child and Adolescent Health and Development, Geneva WHO IMCI indicators at primary health care facility and household levels
The following two links display Annex D and E, respectively, of the WHO IMCI health facility survey manual, listing the IMCI priority and supplemental indicators that can be measured through this survey tool: Indicators for assessing infant and young child feeding practices This document reports the conclusions of a consensus meeting held in Washington DC, USA, 6-8 November 2007, on indicators to assess infant feeding. The indicators include 8 core indicators and 7 optional indicators, are population-based and can be derived from household survey data. Developments in knowledge and recommendations in this area prompted the revision and expansion of the indicators which had been developed earlier and which are described in the two documents below on breastfeeding practices (1991) and complementary feeding (2002), respectively. Indicators for assessing breastfeeding practices This “Report of an informal meeting on indicators for assessing breastfeeding practices” held in Geneva on 11-12 June 1991 [WHO/CDD/SER/91.14] provides the rationale for the selection of key breastfeeding indicators, lists their definitions and describes specific methodologies for their measurement at household level. Indicators for complementary feeding This “Report of an informal meeting to Review and Develop Indicators for Complementary Feeding, held in Washington DC on 3-5 December 2002 describes a set of indicators for assessing complementary feeding. For other information on complementary feeding, consult the full nutrition section of the CAH/HQ website. Top
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